- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,329.83 / $8,882.45 / $14,364.00
| Facility | | $6,329.83 | $8,882.45 | $14,364.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,152.92 / $8,028.66 / $12,934.05
| Facility | | $5,152.92 | $8,028.66 | $12,934.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,521.96 / $7,745.51 / $13,798.00
| Facility | | $5,521.96 | $7,745.51 | $13,798.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58.70 / $85.26 / $137.36
| Facility | | $58.70 | $85.26 | $137.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,082.16 / $8,417.46 / $13,853.19
| Facility | | $6,082.16 | $8,417.46 | $13,853.19 |